Barry J. Wu, MD, is a professor of medicine (geriatrics) at Yale School of Medicine (YSM). This is a lightly edited excerpt from his interview on the Health & Veritas podcast, episode 187, “The Questions to Ask the Elderly.” Listen to the whole interview for more information on how family caregivers and physicians can better understand the needs of older adults.
Q+A
Quick Question: How Can We Ensure Enough Doctors for Our Aging Population?
How Can We Ensure Enough Doctors for the Elderly?
Barry J. Wu, MD: I don’t think we would ever train enough geriatricians to provide the care that is needed. And that’s why I’m into education, and our Connecticut Older Adult Collaboration for Health program is providing education to everybody, not just geriatricians. So the first-year medical students at YSM, the first-year physician associate students, their very first interview with the patient is asking about what we call the 4Ms: mobility, mind, medication, what’s most important.
No matter what profession you’re going into, you’re going to be dealing with geriatric patients, 65 years and older, whether you’re doing it in your specialty or at home. And the more we can train people to listen to what’s important to the person, to see their mobility, to see if they’re getting confused at all, to remove as many medicines as they can safely, the better.
You want to do prevention, prevention, prevention, and education. Everybody needs to be trained in this. It’s like CPR. I think we need to be training geriatric concepts like we do CPR, train everybody in it.
I think the way to teach it is by asking open-ended questions. So I would say, “Mom, what’s most important to you?” Or, “Mom, what bothers you the most?” To get an idea of what matters most. “Mom, how’s your walking? Do you need any help with any walker or wheelchair? Mom, how’s your thinking?” Or you can detect if they’re having problems with their memory. And I also think, especially in older people, really listening if they’re depressed. How’s their mood? Do they seem sad? Because treating and dealing with depression in an older person is very important.
And medication, trying to at least know the list of medicines they are on, and then thinking about what was the goal of the medicine. Being aggressive with medication in a younger person is probably the right thing because they’re looking for longer life. While in an older person, they may be looking for quality of life. So you try to remove any untoward effects from the medicines.
Health & Veritas is hosted by Yale School of Medicine’s Howard Forman, MD, MBA, professor of radiology and biomedical imaging, and Harlan Krumholz, MD, SM, Harold H. Hines Jr. Professor of Medicine (Cardiology).
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